母乳喂养相关黄疸管理研究进展

Research Advances in the Management of Breastfeeding-Associated Jaundice

摘要: 新生儿黄疸是新生儿期最常见的临床现象之一，绝大多数足月及早产儿在生后早期会出现不同程度的胆红素升高。随着全球范围内对母乳喂养益处的广泛认知与推广，母乳喂养率持续上升，与之相关的黄疸问题也日益凸显，成为儿科、产科及儿童保健领域兼具普遍性与特殊性的管理挑战。母乳喂养相关黄疸主要涵盖两种类型：早发性母乳喂养性黄疸，常与生后初期摄入不足相关；以及晚发性母乳性黄疸，指在其他方面健康的纯母乳喂养婴儿中出现的迁延不退的高未结合胆红素血症。虽然大多数病例预后良好，但持续显著的高胆红素水平存在导致胆红素脑病的潜在风险，且其发生常引发家长焦虑，甚至可能导致母乳喂养不必要的中断。因此，如何在坚定支持母乳喂养这一黄金标准的前提下，实现对相关黄疸的科学评估、有效干预与风险管理，是临床实践的核心议题。本综述旨在系统梳理该领域的现有证据，聚焦于管理策略的进展与争议，为临床精准管理提供循证依据。

Abstract: Neonatal jaundice is one of the most common clinical phenomena in the neonatal period, with the vast majority of term and preterm infants experiencing varying degrees of elevated bilirubin levels in the early postnatal period. Alongside the widespread global recognition and promotion of the benefits of breastfeeding, breastfeeding rates have continued to rise. Consequently, jaundice related to breastfeeding has become increasingly prominent, posing both common and unique management challenges in the fields of pediatrics, obstetrics, and child health. Breastfeeding-associated jaundice primarily encompasses two types: early-onset breastfeeding-associated jaundice, often linked to insufficient intake in the initial postnatal days, and late-onset breast milk jaundice, which refers to persistent unconjugated hyperbilirubinemia in otherwise healthy exclusively breastfed infants. Although most cases have a favorable prognosis, sustained and significant hyperbilirubinemia carries a potential risk of bilirubin encephalopathy. Moreover, its occurrence often causes parental anxiety and may even lead to unnecessary interruptions in breastfeeding. Therefore, how to achieve scientific assessment, effective intervention, and risk management of associated jaundice while firmly supporting breastfeeding as the gold standard remains a core issue in clinical practice. This review aims to systematically synthesize existing evidence in the field, focusing on the advances and controversies in management strategies, in order to provide an evidence-based foundation for precision clinical management.